Paediatric oncology and intensive care treatments: changing trends

Abstract

Objectives-To review the outcome of patients with childhood malignancy requiring intensive care treatment and to assess whether there is any secular trend for improved outcome. Design-Retrospective chart reviews of 74 consecutive admissions to a paediatric intensive care unit from a regional paediatric oncology centre between 1990 and 1997. During the same period there were 6419 admissions to the oncology unit, 814 of whom were new cases. Results-The overall survival at discharge from the intensive care unit was 49 of 74. Patients with either systemic or respiratory infection requiring ventilation had the poorest survival (13 of 31) whereas postoperative patients had the best survival (15 of 15). However, patients with respiratory or systemic infection who required inotropic support with more than three agents all died compared with about one quarter of those needing no inotrope. All patients with systemic or respiratory infective illness were neutropenic and positive microbiological identification was possible in 13 of 21 and five of 18, respectively. Non-survivors had a higher mean acute physiology and chronic health evaluation system (APACHE-II) score than survivors (24.2 v 15.94, respectively) but no patient with a score of > 27 survived. Conclusion-Compared with previous series, there has been a great improvement in survival of oncology patients admitted to the intensive care unit especially those with either systemic or respiratory infection needing ventilation. Full intensive care treatment should be provided for these patients. (Arch Dis Child 1999;80:553-555)

Appropriateness of admissions of children with cancer to intensive care facilities in a resource-limited setting

“…9 The number of oncology patients requiring admission to the PICU has increased, reaching up to 40% 12 of patients during the course of their disease in both low-and high-income centres. 6,11,13,14 These children often have severe myelo-and immunosuppression and are more likely than other paediatric patients to require PICU care. 1,14 Timely recognition and early PICU admission offer opportunities to prevent and manage life-threatening complications of cancer management.…”

Comparação dos diferentes escores de gravidade utilizados em unidade de terapia intensiva pediátrica oncológica

“…Dentre os poucos trabalhos publicados, na maioria das vezes, a amostra analisada é pequena, menor que 100 (Sivan et al, 1991;Heney et al, 1992;Veen et al, 1996;Butt et al, 1998;Keengwe et al, 1999;Heying et al, 2001;Abraham et al, 2002;Haase et al, 2003;Kutko et al, 2003;Meyer et al, 2005;Pound et al, 2008;Dursun et al, 2009). Há apenas alguns estudos, incluindo dissertações que analisaram amostras maiores, que oscilaram entre 150 a 400 sujeitos (Hallahan et al, 2000;Dalton et al, 2003;Escobar et al, 2004;Fiser et al, 2005;Da Silva et al, 2008;Tamburro et al, 2008;Pancera et al, 2008).…”

“…Na década de 80, a mortalidade girava em torno de 32~75% (Butt et al, 1988;Heney et al, 1992;Sivan et al, 1991;van Veen et al, 1996), e na década de 90, de 13~34% (Keengwe et al, 1999;Hallahan et al, 2000;Heying et al, 2001;Abraham et al, 2002;Dalton et al, 2003). A partir do final da década de noventa, não se observou diferença na mortalidade entre pacientes oncológicos e não oncológicos com sepse e choque séptico (5,5%-16%) (Kutko et al, 2003;Fiser et al, 2005;Pound et al, 2008).…”

“…São inúmeras as causas que podem levar o paciente oncológico pediátrico a necessitar de suporte em uma UTIP, desde aquelas relacionadas ao tumor, até à intensidade da terapia anti-neoplásica, que, por si, pode levar a complicações graves e fatais (Keengwe et al, 1999;Gutierrez e de Camargo, 2001;Heying et al, 2001;Haase et al, 2003).…”

“…No que se refere à possibilidade desse grupo de pacientes se beneficiar de unidades de terapia intensiva pediátricas (UTIP), diversas pesquisas publicadas nos anos 1990 demonstram taxas de mortalidade acima de 75% para qualquer criança com diagnóstico de câncer admitida nesse setor hospitalar (Keengwe et al, 1999;Hallahan et al, 2000;Goodman et al, 2000;West et al, 2004). Isso porque a intensidade da terapia por si mesma pode levar a complicações graves e condições ameaçadoras da vida, como a síndrome de lise tumoral (SLT) ou choque…”